What are the tonsils for?

Tonsils are small glands found at the back of the throat which are part of the lymphatic system, which means their job is to help fight infection. After about the age of three they gradually reduce in size.

Your body can still fight infections even without your tonsils. However if the tonsils are doing more harm than good, then it may be better to have them removed.

Why take them out?

The commonest reason for taking tonsils out is if they cause frequent and recurrent sore throats despite treatment with antibiotics. Another good reason for removing tonsils is if they are so large that they block the airway. Sometimes small children have tonsils and adenoids that are so big that they block their breathing at night, causing loud snoring and pauses in breathing.

Another reason for removing them is following a quinsy, which is an abscess that develops next to the tonsil as a result of a tonsil infection (tonsillitis). It causes a very severe sore throat, restricted mouth opening and inability to swallow. It is generally regarded as being very much more unpleasant than even a severe bout of tonsillitis. Most people who have had a quinsy would therefore usually choose to have a tonsillectomy to prevent having another.

Tonsils are also removed if a tumour is suspected. This may be suspected if there has been a sudden increase in the size of the tonsil or a change in its surface appearance such as ulceration or bleeding. Often tonsillectomy is recommended in people with tonsils that are of different sizes, although in such circumstances tumours are detected extremely rarely.

Do I have to have a tonsillectomy?

It is not always necessary for the tonsils to be removed. You may want to just wait and see if the tonsil problem gets better by itself, particularly if the problem has been recurrent infections and the episodes have not been too frequent. Problems with breathing are often taken more seriously and would require an operation at an earlier stage than perhaps might be the case for infections alone. Your specialist will be able to explain to you whether surgery is the best treatment for you or your child.

Things to know before a tonsillectomy

It would be advisable to arrange two weeks off work or school. This is because there is a risk of acquiring an infection in the immediate postoperative phase. Please also let us know if you have a chest infection or tonsillitis within the week immediately before the admission date – you may require a course of antibiotics although it may still be necessary to postpone the operation if the infection has not cleared in time.

It is also important to tell us if you have had any unusual bleeding or bruising problems, or if this type of problem runs in the family.

How is a tonsillectomy performed?

Tonsillectomy is carried out whilst you are asleep under a general anaesthetic. The tonsils are taken out through the mouth, and then the bleeding is stopped. This takes about 30 minutes. A child who has had a tonsillectomy will then be taken to a recovery area to be watched carefully as he or she wakes up from the anaesthetic. Different techniques are used, ranging from normal surgical instruments to diathermy (heat generated through an electrical current), lasers and coblation (radiofrequency). There are some differences between these options, and in general your surgeon will choose the technique which he or she is most familiar with and which is best suited to your particular problem. Please ask your specialist for further information about this if you would like to know more.

After a tonsillectomy – what to expect:

It is quite normal for most children to feel a little sick after having the tonsils out. Anti-sickness medicine often needs to be given for this, but it usually settles quickly.

The most obvious thing to expect is a sore throat, which usually lasts for approximately ten days and gets worse before it gets better, reaching a peak at about the 5th – 7th day after the tonsillectomy. It is important to take the prescribed painkillers regularly, half an hour before meals for at least the first week. Aspirin is not safe for children and should never be given to children under 16.

You may have an earache. This is normal – it happens because your throat and ears are connected by the same nerves. It does not mean that you have an ear problem.

If you look inside your mouth you will notice that the throat looks white – this is the normal appearance while your throat heals. You may also see small threads where your tonsils used to be – they are sometimes used to help stop the bleeding during the operation, and will fall out by themselves.

Some people get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your throat. Call your GP or the hospital for advice if this happens.

Adults and children will need 10 to 14 days off work or school. It is advisable to remain indoors for the first week, keeping away from crowded and smoky places and keeping your distance from people with coughs and colds. You may feel tired for the first few days. After the first week it is OK to gradually increase your activity and get back to normal according to how you feel.

When can I go home after having my tonsils out?

In many hospitals, surgeons prefer tonsillectomy patients to stay in hospital for one night although an increasing number of tonsillectomies are now being conducted as a day case. Regardless of the preference of your surgeon or hospital, we will only let you go home once you are recovered from the immediate effects of the operation, when you are eating and drinking and feel well enough.

What can go wrong after a tonsillectomy?

Tonsil surgery is in general very safe, but every operation has a small risk associated with it. The most frequently encountered problem is bleeding. This can occur at any time from immediately after the operation up until two weeks later, and occurs in approximately two to three children in every 100 tonsillectomy operations performed and in up to five adults in every 100 tonsillectomies. In most of these episodes of bleeding however, treatment is mainly medical with antibiotics as the majority of bleeds occur following a throat infection. In approximately one in every 100, a second operation may be required to stop the bleeding.

During the operation, there is a very small chance that a tooth may be chipped or knocked out, especially if it is loose, capped or crowned. Please let us know if you have any teeth like this. Damage or minor cuts to the lips and/or gums can also occur.

It is possible to experience sore throats even long after the tonsillectomy operation, although these will almost certainly be associated with other problems such as a cold or ‘flu rather than true tonsillitis. Also, in children, when the operation is performed for snoring or breathing difficulties, the snoring may not completely disappear but should reduce to a much more acceptable level.

What should my child eat after a tonsillectomy?

The most important advice is to encourage your child to eat as normally as possible. This helps the throat to heal faster and in fact reduces the discomfort. This in turn reduces the likelihood of a postoperative infection and bleeding. The type of food is not as important as regularity. Small amounts of food more regularly is better than big meals once or twice a day. Try to stick to bland, non spicy foods where possible. Plenty of fluids is also important, and chewing gum may also help the pain.

The idea is that taking painkillers regularly will allow your child to eat and drink as normally as possible. This will in turn promote healing and reduce pain, infection and bleeding. The converse is also true in that if pain is allowed to increase, food intake suffers and the pain worsens yet further, leading to an infection and possibly bleeding.

Effect on snoring:

Most parents in fact report that their child is so quiet after the surgery that they are just as worried as they were before the surgery when their child was noisy!

Bleeding after a tonsillectomy:

If you notice any bleeding from your throat, you must seek medical advice. If it is only a drop or two, call your GP or the ward of the hospital where you were treated. However, for anything more severe or if in any doubt, it is advisable to go to your nearest hospital casualty department.